Case Reports

Splenic Hemangioma Presenting as a uHot

Spot" on Radiocolloid Scintigraphy
K.Y. Gulenchyn, M.R. Dover, and S. Kelly
Divisions of Nuclear Medicine and General Surgery, Department of Radiology, Ottawa Civic
Hospital; and the University of Ottawa, Ottawa, Ontario, Canada

The appearance of a splenic hemangioma on radiocolloid scintigraphy has been reported to

be that of a focal photon deficient (esion. We report a case of a patient who presented with
the opposite appearance—that of a splenic "hot spot." We postulate that this appearance
results from increased local blood flow presenting a greater proportion of colloid to the
reticuloendothelial cells surrounding the hemangioma.

J Nucl Med 27:804-806, 1986

k3plenic hemangiomas may be solitary or occur in

conjunction with the presence of multiple disseminated
hemangiomata (1-5). They may be asymptomatic or
result in the presence of a mass or gastrointestinal
symptoms (/). Complications include splenic rupture,
hypersplenism, consumption coagulopathy, and malig-
nant degeneration (/). The incidence of the tumor
varies from 0.03% to 14% in reported autopsy studies
(6-9). Because the incidence of splenic hemangioma in
the general population is not well established, it is
difficult to determine the complication rate.
In view of the seriousness of potential complications,
accurate diagnosis is important. The appearance of
splenic hemangiomata on scintigrams obtained using
radiocolloids has been reported to be that of a focal
photon deficient area (5JO). We report here the case
of a patient who presented in the opposite appearance—
that of a splenic "hot spot."

CASE REPORT

A 30-yr-old male presented with a 2-yr history of fatigue

and gradual weight loss. Over this period of time, he had lost
9 kg. Further questioning revealed complaints of dyspepsia
and intermittent diarrhea. On physical examination, a left
upper quadrant mass was felt at the costal margin.
An abdominal ultrasound demonstrated a circular, well-
defined solid abnormality within the upper pole of the spleen
which was more echogenic than surrounding splenic tissue.

Received June 28, 1985; revision accepted Jan. 10, 1986.
For reprints contact: K.Y. Gulenchyn, MD, Div. of Nuclear
Medicine, Ottawa Civic Hospital, 1053 Carling Ave., Ottawa,
Ontario, Kl Y 4E9, Canada.
FIGURE 1
Ultrasound of spleen demonstrating solid abnormality
within upper pole of spleen more echogenic than surround-
ing tissue with displacement of vascular channels poste-
riorly (d: Diaphragm; s: Normal spleen; m: Mass, v: Vas-
cular channels)

804 Gulenchyn, Dover, and Kelly The Journal of Nuclear Medicine

Displacement of some vascular channels posteriorly was noted
(Fig. 1). A computed tomographic examination of the abdo-

1
men utilizing contrast infusion failed to demonstrate the
splenic abnormality.
Liver/spleen imaging was performed using 4 mCi (150
MBq) of technetium-99m sulfur colloid. Both dynamic and
static images were obtained. The abdominal dynamic images
demonstrated increased flow in the upper left quadrant at a
site corresponding to the area of increased activity seen on
static images at the upper pole of the spleen. This was believed
LAO 30 LAT
to represent a splenic hemangioma or other vascular tumor
(Figs. 2 and 3). A second, less well-defined area of increased
activity was noted inferior to the upper pole abnormality. It

P
was initially felt that this might represent a second, smaller
hemangioma.
Abdominal angiography confirmed the presence of a hy-
pervascular 8-cm mass in the upper pole of the spleen (Fig.
^flfc
4). No evidence of a second hemangioma was noted.
Coagulation studies did not indicate the presence of co-
agulopathy and a splenectomy was performed. Following sple-
nectomy, the remainder of the abdominal cavity was explored
for other vascular malformations and none were found. LPO30 POST
On gross pathologic examination a bulging mass was noted
FIGURE 3
at the hilum of the spleen extending up into the upper pole.
Radiocolloid images of liver and spleen showing focal area
The remainder of the spleen was normal. The spleen weighed of increased activity in upper pole of spleen
350 g and, at its greatest dimensions, measured 14 cm
x 10 cm x 6 cm.
On cut surface, the spleen had a normal red to brown color Microscopic sections from the spleen were normal. Sections
outside the area of the mass. The mass was spherical and 6 from the mass showed prominent dilated vessels, although the
cm in diameter. The cut surface of the mass showed multiple parenchyma surrounding the vessels was normal. The elastic
vascular spaces. The mass was well demarcated from the rest lamina and musculature were absent from the abnormal
of the spleen although there was no true capsule. vessels which showed only a scant amount of fibrous tissue in

f «

4A flfc ttk
^^^B^i -^^^PP| ^^jpwp

FIGURE 2
Radionuclide abdominal angiogram demonstrating focal area (arrow) of increased flow in left upper quadrant

Volume 27 • Number 6 • June 1986 805


FIGURE 4
Selective splenic arteriogram demonstrating hypervascular
mass in upper pole of spleen (arrow)
their walls. The pathologic diagnosis was a splenic heman-
gioma. The patient made an uneventful recovery and has had
no further symptoms.
DISCUSSION
Previously reported cases of splenic hemangiomas
have demonstrated photon deficient areas on liver/
spleen imaging utilizing radiocolloids (5,10). Our pa-
tient has demonstrated that this is not always the case;
a splenic hemangioma may be associated with a splenic
"hot spot."
The hepatic "hot spot" is a well-described abnormal-
ity (7/). The most common cause is a blood flow
abnormality, particularly superior vena cava obstruc-
tion. It is felt that increased abnormal blood flow local-
806 Gulenchyn, Dover, and Kelly
ized to a specific area within the liver presents the
reticuloendothelial cells with a greater portion of colloid
for phagocytosis, compared to the remainder of the
recticuloendothelial cells of the liver.
We would postulate that the increased blood flow to
the splenic hemangioma demonstrated on radionuclide
and contrast angiograms resulted in a greater propor-
tion of colloid being presented to the reticuloendothelial
cells surrounding the hemangioma and creating the
"hot spot."
Only one other report of a splenic "hot spot" could
be found in the literature. This was a spurious finding,
as the localized area of increased activity did not persist
on all views and was felt to be secondary to redundant
splenic tissue at the lower pole of the spleen (12).
The discovery of a splenic "hot spot" on radiocolloid
imaging should lead to further investigation for a
vascular splenic tumor, in particular a splenic
hemangioma.
REFERENCES
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Arch Surg 83:57-64, 1961
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1070, 1940
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agulopathy: Response to splenectomy. Pediatrics
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The Journal of Nuclear Medicine